Incorporating Exercise Science Best Practices into the Work Day - Guest Post

Throughout the history of our blog, we have attempted to highlight all the professions working and dealing with athletes.  One such profession, athletic trainers, are an imperative component to any program dealing with athletes.  However, all too often we think of this role being limited to the athletic field when in all actuality, athletic trainers serve a variety of key and important roles. 

The following guest blog is brought to us by Valerie Lisiecki, ATC is the Head Athletic Trainer for The Injury Prevention Specialists or IPS (www.preventworkinjury.com) that highlights just that.  She has been a certified athletic trainer for 8 years and specializes in sports medicine for the occupational athlete. She is a Level 2 Certified Ergonomics Assessment Specialist and uses her expertise to provide onsite care for a manufacturer with 580 employees.  Thank you Valerie for your contribution to the profession and this blog.

Incorporating Exercise Science Best Practices into the Work Day

Injury prevention is important in any setting, but becomes even more important when it applies to athletes. Athletes use their bodies in extreme ways to perform a skill. It is imperative that they maintain strength, flexibility, and health in order to optimize performance and results. Some professionals apply these principles and their expertise in biomechanics and ergonomics to both assist with performance optimization and prevention of injuries in a similar fashion in the occupational athlete.

Athlete is defined as “a person trained or gifted in exercises or contests involving physical agility, stamina, or strength; a participant in a sport, exercise, or game requiring physical skill.” This definition reaches beyond a traditional athlete and includes a certain sect of individuals known as Occupational Athletes.

Occupational Athletes will likely develop multiple musculoskeletal problems throughout their career. The long-time employees, and/or aging workforce, are especially susceptible because they have spent a longer time using physical labor, hour after hour, day after day, and year after year. If you can imagine yourself doing strenuous yard work or painting a house for an entire 8-hour day, then you can then imagine how that might make your body feel for the next two days. Occupational Athletes do these things daily, in varying degrees, without much time for rest.

IPS or The Injury Prevention Specialists brings sports medicine and exercise science into the workplace. The same programs that football, basketball, and soccer athletes use on the field or on the court can be applied to occupational athletes to prepare their bodies to meet the functional demands of their workplace.

IPS uses athletic trainers (ATs) to provide employer-based and OSHA compliant injury prevention programs. Athletic trainers are health care professionals who are nationally certified and licensed to prevent, assess, and rehabilitate musculoskeletal injuries under the direction of a physician. Athletic trainers trained in this area also have a wealth of knowledge of biomechanics and ergonomics which proves to be invaluable when implementing workplace ergonomic and exercise programs.

Occupational Athletes typically put their bodies in awkward postures throughout the day for an extended period of time. Habits form when an employee is looking to get the job done quicker or better at the risk of poor posture and/or ergonomics. That is the opportunity for athletic trainers to incorporate ergonomic improvements and make a positive impact.

The IPS Occupational Athlete Program is designed for easy implementation and complements any workplace ergonomics program that is already in place. The Occupational Athlete Program is the science of fitting employees to the workplace. IPS provides onsite injury assessments with root cause analysis, first aid, and comprehensive ergonomic analysis. IPS implements stretching and strengthening programs, medical case management, emergency response, and health and wellness initiatives.

Onsite athletic trainers are able to triage and handle most injuries before employees reach a physician. This saves the employee from having long bouts of time between points of care which dramatically reduces the time needed for recovery, improves the quality of care and increases customer satisfaction. This also enables the athletic trainer to recognize the problem at the source before an injury gets so far along that it becomes less manageable through conservative care and ergonomic changes. The onsite athletic trainer can also work one-on-one with the employee at their actual workstation while they perform their job tasks.

We know that an athletic trainer on the sidelines helps to reduce injuries, expedites care and improves return to sport.  This results in decreased health care costs, improved recovery time and decreased time on the disabled list.  This is similar to the occupational athlete athletic trainer.  The convenience of an onsite athletic trainer reduces new Workers’ Compensation claims, OSHA recordable injuries and rates, days away from work, job transfer, and restricted work. The work-related medical expenses decrease while employee productivity increases.

IPS employs experts in workplace injury prevention and Certified Ergonomic Assessment Specialists (CEAS). They bring sports medicine research into the workplace to battle work-related injuries at the root cause. Workplace injuries can affect the bottom line in any company and especially when OSHA begins to notice when there are too many workplace injuries in a particular location.  This can aid to increased legal fees, increased frequency of inspections and costly implementation of stringent work place policies and restrictions. IPS has proven the injury prevention strategy with manufacturers, warehouses, aviation maintenance, service industries, and office employees.  One case in point where an onsite athletic trainer impacts injury rates in the occupational athlete.

A self-insured Fortune 500 Company with approximately 350 production and 150 office employees. They were averaging approximately $300,000 in direct workers’ compensation expenses and had an annual OSHA Recordable Rate that was almost double the industry average. They implemented a full-time onsite athletic trainer and in 18 months their workers’ compensation expenses were reduced by over 90% and their OSHA Recordable Rate decreased by 80%.  

Over the course of 8 years the company has saved >$2M in direct workers’ compensation expenses and has prevented over 250 OSHA Recordable Injuries. They have been nationally recognized as a safety site of excellence and other sites throughout the US have started to adopt their model of injury prevention.

Implementation of this same model with athletic trainers in medium sized companies has similar results.  An athletic trainer implemented in a medium-sized manufacturing employer of approximately 120 employees and in two short months prevented over $36,000 in direct workers’ compensation expenses. That equals a return on investment of $15 saved for every $1 spent.

Athletic trainers help to prevent overuse, repetitive, and static motion injuries. This is accomplished by addressing workstation organization, function, and placement of tools or computers. A workforce is just like a sports team, and when an employee or a teammate is injured the group is weakened. It is important to strengthen the individuals in the workforce or on the team in order to operate at full capacity for optimal results.

For more information about workforce readiness or onsite athletic trainers. (904) 508-5800 www.prevenworkinjury.com.  You can also check us out on social media for weekly tips and injury prevention articles.

Just another testament on how athletic trainers can help you avoid injuries and perform better.  As simple as it sounds,  move better, feel better, perform better and last longer.  That simple.   If you like what you see, SHARE THE PASSION!  It is the biggest compliment you can give.  Follow us on Twitter @ACL_prevention and tweet about it.  #MovingToChangeMovement and help us spread the passion.

Trent Nessler, PT, MPT, DPT:  National Director for Sports Medicine – Physiotherapy Associates | Author | Educator |Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and owner of Athletic Therapy Services.  He serves as National Director of Sports Medicine and movement change consultant for practices and organizations looking to develop injury prevention initiatives and strategies.  He has been researching and developing movement assessments and technologies for >10 years is the author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.  You can contact him directly at trent.nessler@myphysio.com

To Change Movement - We Must 1st Change - Part IV

Last week, we concluded our discussion talking about a recent study by Boren et al where they looked at MVC of gluteus medius and maximus for various exercises commonly used to strengthen the hip and increase stability in single limb performance.   

As a recap, what was found was five of the exercises produced greater than 70% MVC of the gluteus medius muscle.  These were:

• Side plank abduction with dominate leg on the bottom – 103% of MVC
• Side plank abduction with dominant leg on top – 89% MVC
• Single leg squat – 82% MVC
• Clamshell progression #4 – 77% MVC
• Front plank with hip extension – 75% MVC

Five of the exercises produced greater than 70% MVC for the gluteus maximus muscle.  These were:

• Front plank with hip extension – 106% MVC
• Gluteal squeeze – 81% MVC
• Side plank abduction with dominate leg on top – 73% MVC
• Side plank abduction with dominate leg on bottom – 71% MVC
• Single leg squat – 71% MVC

Discussion:  Based on the results of this study, it leads us to some indication of types of exercises we can do with our patients that will result in MVC of the gluteus medius and gluteus maximus.  That said, is this always the right kind of training and more importantly is this the most functional? 

The front plank with hip extension and the side plank shown here are great exercises for the glutes as well as the core.  This study as well as others show that improvements in these motions as well as the MVC of the associated musculature aids in stability in single limb performance.  But is this a start and end point?  One thing we must ask ourselves is, does this have carry over to full weight bearing upright positions?  Are the length tension relationships the same and is the neurological input to the system the same as when you are standing.  Full weight bearing upright postures result in very different neurological input to the system as well as muscle activation.  So, although this may be a great exercise and a great starting point, it is not or should not be an end point.  The goal of exercises we use toward the conclusion of rehabilitation and/or in preparation for return to sport or while in sport is to have similar MVC on these muscles in upright training postures.  This trains the body, the neurological system and the brain to maximally activate these muscles in more functional postures. 

When looking at the single limb squat motion picture here, according to the study, this has both high MVC of the gluteus medius and maximus.  This is also an exercise performed in upright full weight bearing postures.  But, is this position similar to that of sport?  If you compare this position to that of sprinting, is there a way we could do this same exercise that closer represents a true sprint position?  If you look at the epidemiology and video studies looking at mechanisms of injury related to non-contact ACL injuries what you typically find is rupture occurring in more of a landing position with the contralateral limb in either extension or slight extension and abduction.  So, although this is a great starting point, is this the end point?

Again this goes back to the initial discussion.  What we are discussing here is not taking the data simply as is.  Rather, we are taking the most current literature and applying practical application and knowledge to that.  But one KEY factor here.  Throughout this discussion, the practical application is back up with solid science as the foundation of why we make the modifications that we do. 

To dive into this discussion a little bit further, lets look at single limb symmetry.  We mentioned previously that studies indicate that asymmetry in single limb performance or movement is an indicator of risk.  Clinically we have known this and the research has started to prove and look at this a little more in depth in the last 5-6 years.  One measure of this that has come out recently is what is defined as the Limb Symmetry Index (LSI).  The LSI is a comparison of the injured limbs performance to the uninjured limbs performance on a battery of single limb activities.  One recent study clearly shows this.  In 2015, Rohman et al looked at single limb performance as a measure or indicator for an athletes ability to return safely to sport. 

Methods:  Retrospective case series of 122 patients who underwent ACL reconstruction and who received postoperative Standard Functional Tests (SFTs).  10 of the 12 individuals tests within the SFT were analyzed for change in limb symmetry index (LSI) and absolute function in each limb. 

Results: In all athletes, involved limb performance increase in all tests.  LSI significantly improved in 6 tests with 5 of the 5 of the tests which showder initial LSI below 90%.  These tests were: single leg squat, retro step up, single leg hop, crossover triple hop, and timed hop.  Retro step up and single leg hop showed LSI improvements greater than 10%. 

Discussion:  As impressive and exciting as these results are, there is one thing that must be considered when reading through the results.  Does improvement in the LSI scores result in decreased risk of re injury, improved performance and improved short and long term outcome.  The easy answer and logical answer would be yes.  But, that is not what this study showed.  There was not a retrospective analysis of re-injury rates, comparison of pre-injury performance to post injury performance measures nor comparison of short and long term outcome measures.    What we can conclude based on previous studies is that we know improvement in the LSI does reduce risk.  How much, that we do not know.  We also know that improve symmetry (not LSI) does result in improved sprint speed and vertical jump.  Does improvement in LSI (as measured here) also improve sprint speed and vertical jump?  That we don’t know.  Finally, we know that lack of symmetry adds to increased risk of osteoarthritis later in life and more patella-femoral pain syndrome.  Does improvement in LSI also equate to those same improvements?  That we don’t know.

So, based on these last 2 blogs, what do we know?  We know some great exercises that will aid in improving strength of the gluteus medius and maximus.  We also know we should consider progressions which bring athletes into more upright, sport specific postures.  We also know that there are ways to quantify and express single limb symmetry, Limb Symmetry Index (LSI).  We also know that if we can improve the stability during these testing positions, then we can improve LSI and potentially reduce risk.  So, this would tell us that we need to train to improve performance on these tests.

As basic as it sounds, to truly change movement, we must change the way that we think.  And although it is not 100% data driven, it is 150% science driven.  Move better, feel better, perform better and last longer.  That simple.   If you like what you see, SHARE THE PASSION!  It is the biggest compliment you can give.  Follow us on Twitter @ACL_prevention and tweet about it.  #MovingToChangeMovement and help us spread the passion.

Trent Nessler, PT, MPT, DPT:  Physical Therapist | Author | Educator |Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and owner of Athletic Therapy Services.  He serves as a practicing clinician and movement change consultant for practices and organizations looking to develop injury prevention initiatives and strategies.  He has been researching and developing movement assessments and technologies for >10 years is the author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.  You can contact him directly at drtrent.nessler@gmail.com

To Change Movement - We Must 1st Change - Part III

Over the last couple of weeks, we have talked about the current research and how this should influence the way we think and approach our our athletes both from a rehabilitation standpoint and from a training perspective.  There are several thought leaders out there that will say that the push for evidence based practice has caused us to be too data driven and not applying enough common sense or experience to what we do with our athletes.  I would agree to some degree but also question if the way we did things in 1980s is still the way we should do things today.  So, although I agree it is bad to rely souly on data, it is also an injustice to the athlete to not apply what we know from the literature to what we do today.  Science does drive everything.  Applied correctly and it can and wil make a good athlete a great athlete.

That said, there is also a flip side to this discussion.  Those who practice that are heavily or souly evidence based practice will ask for a study for everything you do.  Do I really need a study to show me that I should not bang my thumb with a hammer or that in doing so will negatively impact my grip strength?  No!  I know from experience that if I do, that it will hurt and greatly reduce the strength in my grip.  So, I don’t need a study to show me that.  Knowing this is one extreme end of the spectrum, it aids in further clarifying my point.  Experience is important and sometimes the most effective things we do have not YET been validated in the research.  In considering both sides of this argument, we should consider where does innovation come from?  It comes from experience.  Many of the innovations in sports medicine come from pioneers in the profession who see a problem, develop a solution or approach and then validate this over time with anecdotal data (working with athletes) and eventually support and validate in the research.  For truly successful innovations will find themselves in the research eventually where they will be validated and furhter excepted as a part of evidence based practice.  However, those that rely souly on experience and who completely ignore the research, is this truly in the best interest of the athlete?

Considering this discussion, in 2011 Grindem et al suggested that asymmetries in single limb performance placed athletes at a greater risk of injury.  This is a fact that many practicing in sports medicine clinicians and coaches already suspected and were addressing as both a part of their treatment and training.  Many were already looking for ways in which to quantify single limb assymetry and develop specific training protocols to address the deficits which lead to single limb strength assymetry.  Over time, as clincians were looking for causes for this SL assymetry, many realized there was a connection between hip strength and lack of stability or control of the lower limb.   This was validated in studies in 2005 looking at patellafemoral syndrome and yet still was not a part of the standard of practice.  Since this time, there have been multiple studies further validating that improvements in hip strength symmetry aided in reducing single limb assymetry.  One such paper was in 2014 in which Stearns et al showed that improvements in hip strength resulted in reduction of adduction toward midline in jumping tasks.  This reduction in hip adduction was directly correlated to reductions in the adduction moment which reduces the risk for ACL injury.

So, if we know that SL performance is improved with hip strengthening, what are the best exercises to train the hip?  In 2011, Boren et al published a paper, we get some answers to this question.  As discussed in previous blogs, the gluteus medius is a critical muscle in the hip that aids in control of the pelvis and lower limb, especially in single limb performance.  Therefore, building strength and endurance of this muscle is vital when addressing single limb assymetry.  However, there are hundreds of exercises that are used to strengthen the glutues medius and yet very little evidence showing which ones are optimal.  In this study, the authors set out to test the MVC (maximal volitional contraction) of some of the more commonly used gluteus medius exercises. 

Methods:  Twenty six healthy subjects participated and had surface EMGs placed on both the gluteus medius and gluteus maximus muscle bellies.  MVC for the gluteus medius and maximus was established for each subject.  Each subject then performed 18 different exercises during which the MVC of the gluteus medius and maximus was measured. 

Results:  Five of the exercises produced greater than 70% MVC of the gluteus medius muscle.  These were: 

• Side plank abduction with dominate leg on the bottom – 103% of MVC 
• Side plank abduction with dominant leg on top – 89% MVC 
• Single leg squat – 82% MVC  
• Clamshell progression #4 – 77% MVC  
• Front plank with hip extension – 75% MVC

Five of the exercises produced greater than 70% MVC for the gluteus maximus muscle.  These were: 

Front plank with hip extension – 106% MVC 

• Gluteal squeeze – 81% MVC 
• Side plank abduction with dominate leg on top – 73% MVC 
• Side plank abduction with dominate leg on bottom – 71% MVC 
• Single leg squat – 71% MVC

Now, as an evidence based clinician, I have a clear indication of the exercises I should be using with my patient who has single limb assymetry.  Or do I?  We will discuss that in more detail next week.  If you like what you see, SHARE THE PASSION!  It is the biggest compliment you can give.  Follow us on Twitter @ACL_prevention and tweet about it.  #MovingToChangeMovement and help us spread the passion.

Trent Nessler, PT, MPT, DPT:  Physical Therapist | Author | Educator |Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and owner of Athletic Therapy Services.  He serves as a practicing clinician and movement change consultant for practices and organizations looking to develop injury prevention initiatives and strategies.  He has been researching and developing movement assessments and technologies for >10 years is the author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.  You can contact him directly at drtrent.nessler@gmail.com

To Change Movement - We Must 1st Change - Part II

 Last week we were discussing the latest research related to injury risk and impact of psychology with return to sport.  Specifically, we were discussing Ardern et al paper from 2013 where the authors looked at the psychological factors influencing return to sport.  We concluded that discussion talking about how the therapist, athletic trainer or performance coach influences the sport locus of control. 

Another factor touched on in this article was fear.  So, another key take away is the rehab provider’s ability to build the patient’s confidence during the course of rehabilitation.  Most fear full body weight support on the involved limb and single limb landing and cutting on the involved side.  There are a lot of ways to minimize this fear, one of which is getting them to do single leg activities early (within protocol and MD clearance) and often.  Building the confidence in the limb as soon as possible so that they can see putting weight on the leg will not result in re-injury.  Make them work it.  Making an athlete work hard and pushing them physically will build mental toughness and confidence.  All too often, we are afraid to push patients.  If done within the parameters of the healing process and within protocol, it can and will result in huge physiological and psychological improvements.  But it must be based on sound principles.  We must also be willing to take them to the next step!  Physical therapist are notorious for stopping rehab within the clinic walls.  For athletes, if they are ever to return to the field and to the same level of performance, we must be willing to progress them to that step.  That means taking them on the field and have a sound and systemic approach to more aggressive agility work.  Pushing with in the physiological parameters of healing to push the psychological parameters of the athlete.

Sounds basic right?  Unfortunately it is not.  Let’s look at the following scenario.  The following picture demonstrates an athlete who was being evaluated for returned to sport.  The athlete was psychologically ready to return but further investigation of his program showed he was not doing a lot of aggressive single limb exercises nor progressed to any type of agility work.  When assessing his single limb performance, there was a clear variance in symmetry between the right side and the left side on multiple single limb closed kinetic chain tests.  So, although this athlete was psychologically prepared now, would he be when he returned to the field?  Knowing the level of play this athlete was at and how so many of these athletes are intimately aware of their bodies, one might conclude that when he started some aggressive sprinting and agility work, he would sense this mass variation.  Would this not play into his psychology during play and impact his performance? 

Consider for a moment an RGIII or GSP.  Phenomenal athletes and very physical specimens in their respective sport.  Even though they were “ready” to return to sport, you could see notable asymmetries in single limb performance in both and as a casual observer, you could see hesitation with movement to the involved side.  Most would say, in both cases, that these athletes also had some deep (maybe subconscious) fear of moving to that side and it dramatically impacted their performance. 

So, let’s go back to what we said at the beginning of this series. We have to get better at preventing injuries.  Despite the last 15 years of biomechanical research related to non-contact injuries and risk factors, we simply are not that much better at preventing them.  In 2014, Dodwell et al showed, despite all we have learned, there has been a dramatic increase in pediatric ACL injuries over the last 20 years.  Similar results were demonstrated by Mall et al in 2014 when looking across multiple age groups.  So is it that we are simply getting better at diagnosing these problems or is it that there is truly an increase.  We don’t know the answer to that question but based on what we do know, we can make some assumptions.  In 2015, Jaynathi et al showed that early specialization significantly increased the risk for serious overuse injuries in youth athletics.  Considering the plethora of research available, today, we still assess and treat the way we did 10+ years ago.  In some instances, we may assess movement but we do it in such a rudimentary way that it does not assess for the what the research suggest are risk factors.  Based on the most current research, it might suggest that we consider the following when assessing risk:

• Age/Gender
• Sport/Single sport or multiple
• Previous knee/ACL injury
• History of concussion
• BMI
• Movement
• Gmed/Gmax strength relative to % body weight
• Limb symmetry
• Impact of fatigue

This is obviously not an all inclusive list but is a list that is based on the most current research.  All of these factors we can test and ironically, if movement/symmetry is improved, there is also a huge impact to athletic performance.  Some coaches will say that they get this and know this intuitively.  They are the exception.  To truly and profoundly impact injury rates, we have to come up with a better, more reliable, more sensitive and efficient way that this can be done for the masses.   

After doing this for over 17 years, there is a couple of things that are apparent to me.  One is that everyone moves different but there is always an opportunity to optimize that for performance improvement and reduced injury risk.  Second is that I learn something new everyday.  If you are closed minded and believe you have it figured out, you will NEVER know more than what you know today!  I simply am not that smart and every athlete I see and every coach, athletic trainer and physical therapist I meet teaches me something new.  If you like what you see, SHARE THE PASSION!  It is the biggest compliment you can give.  Follow us on Twitter @ACL_prevention and tweet about it.  #MovingToChangeMovement and help us spread the passion.

Trent Nessler, PT, MPT, DPT:  Physical Therapist | Author | Educator |Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and owner of Athletic Therapy Services.  He serves as a practicing clinician and movement change consultant for practices and organizations looking to develop injury prevention initiatives and strategies.  He has been researching and developing movement assessments and technologies for >10 years is the author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.  You can contact him directly at drtrent.nessler@gmail.com

To Change Movement - We Must 1st Change

No matter what side of the debate you sit on in regards to the health care, one thing is clear.  Change is needed!  As a physical therapist, I can say that a lot of the changes will negatively impact me and my practice.  That said, there are some very good things that will be coming out of the change and that is forcing more accountability in the care that is provided.  For physical therapists to have to be forced to measure outcomes is appalling.  Frankly, this should have been done over 15 years ago.  If we had, the standard of treatment that is provided today would be elevated and reflective of current evidence.  In my humble opinion, the term evidence based practice should not exist.  Instead, it should be the standard of practice that health care providers use the latest research to drive the way we practice.  But the sad reality is, this is not the case. 

The intent of our blogs is to present the most current research and provide us with how we might interpret this in application of what we do as health care providers, coaches or performance specialists.  It is one person’s opinion and as we all know there are multiple ways to interpret the literature.  The intent is to use research to question some of the conventional wisdom.  For someone to simply do things the way we always have because it works is not innovation.  What if we could use the research to tweak what we do to make it that much better?  There is a fine line between research and what can be practically applied in the clinic or field.  But true leaders and innovators are constantly striving to do that.  Take what we know from the research and find innovative ways to apply that to what we do in the clinic or on the field for even superior results.

The reality is that injuries impact future performance.  In 2012, McCullough et al found that only 43% of high school athletes who had an ACL reconstruction returned to their prior level of performance. In 2014, Rugg et al found that Division I athletes who suffered a knee injury prior to their Division I athletic career were at higher risk of re-injury, spent more days on the disabled list and cost the university more in health care dollars during their Division I athletic career.  So, iIs that necessarily a performance issue?  Heck yeah!  If I recruit a star player who has had a previous knee injury and he is on the sidelines 50% more of the time and injured, then he is not adding to my team’s performance.   

In April 2015, Ardern et al looked at athletes 2 years out from ACL reconstruction who had not returned to sport one year post.  Interestingly enough, they found very similar results to that of McCullough et al, where 66% had returned, only 41% were playing at their pre-injury level of sport and 25% were playing at a lower level.  This study also found that one of the factors influencing return to play at pre-injury level was psychological factors.  This highlights several key factors.  One is that an athlete returning to sport does not necessarily mean they are returning to the same level of sport or performance.  The other is the psychological impact that an injury can have on an athlete impacts their future performance.  Ardern et al further highlighted the impact psychology has on return to prior level of play in his 2013 paper.  Here, the authors found the major psychological factors influencing an athlete’s ability to return to the same level of sport were psychological readiness, fear of re-injury, and sport locus control (ability to control their destiny). 

So what is the take home from this.  One is that we simply have to get better at preventing the injuries!  We will talk about that in a minute.  But the second point is we need to address the psychology of the athlete early in the process.  One key take away is the role of the rehab provider in psychologically preparing the athlete and providing them the sport locus control.  If you are not personally vested in assisting the athlete achieving success, if you approach it with apathy, then you are doing the athlete a serious disservice.  Your psychological state has a direct and profound impact on the athlete.  As a provider, our role is as an educator and coach, with emphasis in this case on coach.  Coaching is not passive.  It is methodical in approach, motivational, inspirational and purposefully driven to the end goal all while also being empathetic to the athlete.  Empathy does not mean baby the athlete but relate to the athlete!  If done right, it also gives the athlete the sport locus control.  Making sure they know they have a responsibility and active role in the process and it takes hard work, persistence and determination, but at the end of the day, they can and will control their destiny.

Next week, we will continue this discussion.  If you like what you see, please SHARE THE PASSION!  It is the biggest compliment you can give.  Follow us on Twitter @ACL_prevention and tweet about it.  #MovingToChangeMovement and help us spread the passion.

Trent Nessler, PT, MPT, DPT:  Physical Therapist | Author | Educator |Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and owner of Athletic Therapy Services.  He serves as a practicing clinician and movement change consultant for practices and organizations looking to develop injury prevention initiatives and strategies.  He has been researching and developing movement assessments and technologies for >10 years is the author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.  You can contact him directly at drtrent.nessler@gmail.com